Provider Demographics
NPI:1447280581
Name:BRIAN L. FAST, PSY.D. AND STEPHEN P. GREGGO, PSY.D, PSYCHOLOGISTS, P.C
Entity type:Organization
Organization Name:BRIAN L. FAST, PSY.D. AND STEPHEN P. GREGGO, PSY.D, PSYCHOLOGISTS, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-439-0033
Mailing Address - Street 1:29 JAY UNIT 1067
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12301-3307
Mailing Address - Country:US
Mailing Address - Phone:518-374-7555
Mailing Address - Fax:518-374-6898
Practice Address - Street 1:196 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1227
Practice Address - Country:US
Practice Address - Phone:518-439-0033
Practice Address - Fax:518-439-7167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01727095Medicaid
NY54915AMedicare PIN